Certain medications require prior authorization. Your pharmacist will help you arrange for these drugs. Physicians must call Express Scripts.
Narcotic analgesics are subject to prior authorizations and state regulations.
Express Scripts’ prior authorization (PA) policies include the brand medication and any available generics for that brand.
Express Scripts
(800) 753-2851 — Physicians only
Oncology Treatment
Call eviCore at (888) 910-1199.
Drug Classes Requiring Approval by the Benefit Fund
- Blood factor products
- Rare diseases (e.g. Fabry’s Disease, Gaucher’s Disease)
View a complete list of drug classes requiring approval by the Benefit Fund.
Call the Benefit Fund at (646) 473-7446.
Subject to Change
Drugs Requiring Prior Authorization Effective July 2018
| Drug Target | Therapy Class |
|---|---|
| Abstral | Pain - Narcotic |
| Actemra IV | Inflammatory Conditions |
| Actemra SC | Inflammatory Conditions |
| Actiq | Pain - Narcotic |
| Adcirca | Pulmonary Hypertension |
| Adderall XR | Attention Disorders |
| Adempas | Pulmonary Hypertension |
| amphetamine sulfate | Attention Disorders |
| Ampyra | Multiple Sclerosis |
| anabolic steroid | Hormone Supplementation |
| Androderm | Endocrine Disorder |
| AndroGel | Endocrine Disorder |
| Aptensio XR | Attention Disorders |
| Aralast NP | Metabolic, Immune Disorders or Inherited Rare Disease |
| Aranesp | Blood Cell Deficiency |
| Arcalyst | Metabolic, Immune Disorders or Inherited Rare Disease |
| Atralin gel | Skin Conditions |
| Aubagio | Multiple Sclerosis |
| Austedo | Neurological Disorders |
| Aveed | Endocrine Disorder |
| Avita | Skin Conditions |
| Avonex | Multiple Sclerosis |
| Axiron | Endocrine Disorder |
| Belviq | Weight Loss |
| Benlysta | Metabolic, Immune Disorders or Inherited Rare Disease |
| Benzphetamine Hcl | Weight Loss |
| Berinert | Metabolic, Immune Disorders or Inherited Rare Disease |
| Betaseron | Multiple Sclerosis |
| Bivigam | Metabolic, Immune Disorders or Inherited Rare Disease |
| Botox | Neurological Disorders |
| Bunavail | Pain - Narcotic |
| Bydureon | Diabetes |
| Byetta | Diabetes |
| Carimune | Metabolic, Immune Disorders or Inherited Rare Disease |
| Caverject | Impotence |
| Caverject Impluse | Impotence |
| Cayston | Anti-infectives |
| Chemet | Chelating Agents |
| Chenodal | Metabolic, Immune Disorders or Inherited Rare Disease |
| Cholbam | Metabolic, Immune Disorders or Inherited Rare Disease |
| Cimzia | Inflammatory Conditions |
| Cinqair | Asthma Specialty |
| Cinryze | Metabolic, Immune Disorders or Inherited Rare Disease |
| Concerta | Attention Disorders |
| Contrave | Weight Loss |
| Copaxone | Multiple Sclerosis |
| Copegus | Hepatitis C |
| Corlanor | Heart Failure |
| Cosentyx | Inflammatory Conditions |
| Daklinza | Hepatitis C |
| Daliresp | Blood Cell Deficiency |
| Daraprim | Metabolic, Immune Disorders or Inherited Rare Disease |
| Daytrana | Attention Disorders |
| Delatestryl | Endocrine Disorder |
| Depo - Testosterone | Endocrine Disorder |
| Desoxyn | Attention Disorders |
| Dexedrine Spansules | Attention Disorders |
| dexmethylphenidate HCL | Attention Disorders |
| dextroamphetamine sulfate | Attention Disorders |
| dextroamphetamine sulfate tablets | Attention Disorders |
| diclofenac sodium | Skin Conditions |
| Dificid | Anti-infectives |
| Dupixent | Skin Conditions |
| Dyanavel XR | Attention Disorders |
| Dysport | Neurological Disorders |
| Edex | Impotence |
| Egrifta | Endocrine Disorder |
| Eligard | Endocrine Disorder |
| Emflaza | Metabolic, Immune Disorders or Inherited Rare Disease |
| Enbrel | Inflammatory Conditions |
| Endari | Metabolic, Immune Disorders or Inherited Rare Disease |
| Entresto | Heart Failure |
| Entyvio | Inflammatory Conditions |
| Epclusa | Hepatitis C |
| Epogen | Blood Cell Deficiency |
| epoprostenol sodium | Pulmonary Hypertension |
| Esbriet | Respiratory Miscellaneous |
| Euflexxa | Osteoarthritis |
| Evekeo | Attention Disorders |
| Exjade | Iron Chelators |
| Extavia | Multiple Sclerosis |
| Eylea | Eye Conditions |
| Fabior 0.1% foam | Skin Conditions |
| fentanyl | Pain - Narcotic |
| Fentora | Pain - Narcotic |
| Ferriprox | Iron Chelators |
| Firazyr | Metabolic, Immune Disorders or Inherited Rare Disease |
| Flebogamma DIF | Metabolic, Immune Disorders or Inherited Rare Disease |
| Flolan | Pulmonary Hypertension |
| Focalin | Attention Disorders |
| Focalin XR | Attention Disorders |
| Forteo | Bone Conditions |
| Fortesta | Endocrine Disorder |
| Gammagard | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gammagard Liquid | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gammagard S/D | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gammaked | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gammaplex | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gamunex | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gamunex-C | Metabolic, Immune Disorders or Inherited Rare Disease |
| Gel-One | Osteoarthritis |
| Genotropin | Endocrine Disorder |
| Genvisc | Osteoarthritis |
| Gilenya | Multiple Sclerosis |
| Glassia | Metabolic, Immune Disorders or Inherited Rare Disease |
| Glatopa | Multiple Sclerosis |
| Gocovri | Neurological Disorders |
| Granix | Blood Cell Deficiency |
| Grastek | Allergies |
| H.P. Acthar Gel | Metabolic, Immune Disorders or Inherited Rare Disease |
| Harvoni | Hepatitis C |
| Hetlioz | Sleep Disorder |
| Hizentra | Metabolic, Immune Disorders or Inherited Rare Disease |
| Humatrope | Endocrine Disorder |
| Humira | Inflammatory Conditions |
| Hyalgan | Osteoarthritis |
| Hymovis | Osteoarthritis |
| Hyqvia | Metabolic, Immune Disorders or Inherited Rare Disease |
| ibandronate sodium | Bone Conditions |
| Ilaris | Metabolic, Immune Disorders or Inherited Rare Disease |
| Increlex | Endocrine Disorder |
| Inflectra | Inflammatory Conditions |
| Ingrezza | Neurological Disorders |
| Juxtapid | High Blood Cholesterol |
| Kalbitor | Metabolic, Immune Disorders or Inherited Rare Disease |
| Kalydeco | Respiratory Miscellaneous |
| Keveyis | Metabolic, Immune Disorders or Inherited Rare Disease |
| Kevzara | Inflammatory Conditions |
| Kineret | Inflammatory Conditions |
| Korlym | Endocrine Disorder |
| Krystexxa | Gout |
| Kuvan | Metabolic, Immune Disorders or Inherited Rare Disease |
| Kynamro | High Blood Cholesterol |
| Lazanda | Pain - Narcotic |
| Lemtrada | Asthma/COPD |
| Letairis | Pulmonary Hypertension |
| Lidocaine | Pain |
| Lovaza | High Blood Cholesterol |
| Lucentis | Eye Conditions |
| Lupaneta | Endocrine Disorder |
| Lupron Depot | Endocrine Disorder |
| Lupron Depot-Ped | Endocrine Disorder |
| Macugen | Eye Conditions |
| Makena | Hormone Supplementation |
| Metadate CD | Attention Disorders |
| Metadate ER | Attention Disorders |
| Methylin | Attention Disorders |
| methylphenidate | Attention Disorders |
| methylphenidate ER | Attention Disorders |
| methylphenidate HCL | Attention Disorders |
| Mircera | Blood Cell Deficiency |
| modafinil | Narcolepsy |
| Moderiba | Hepatitis C |
| Monovisc | Osteoarthritis |
| Muse | Impotence |
| Myalept | Endocrine Disorder |
| Myobloc | Neurological Disorders |
| Natesto | Endocrine Disorder |
| Natpara | Endocrine Disorder |
| Neulasta | Blood Cell Deficiency |
| Neupogen | Blood Cell Deficiency |
| Norditropin | Endocrine Disorder |
| Northera | Neurological Disorders |
| Nplate | Metabolic, Immune Disorders or Inherited Rare Disease |
| Nucala | Asthma Specialty |
| Nuedexta | Neurological Disorders |
| Nutropin AQ Nuspin | Endocrine Disorder |
| Nuvigil | Narcolepsy |
| Ocaliva | Metabolic, Immune Disorders or Inherited Rare Disease |
| Ocrevus | Multiple Sclerosis |
| Octagam | Metabolic, Immune Disorders or Inherited Rare Disease |
| Ofev | Respiratory Miscellaneous |
| Omnitrope | Endocrine Disorder |
| Onsolis | Pain - Narcotic |
| Opsumit | Pulmonary Hypertension |
| Oralair | Allergies |
| Orencia | Inflammatory Conditions |
| Orenitram | Pulmonary Hypertension |
| Orkambi | Respiratory Miscellaneous |
| Orthovisc | Osteoarthritis |
| Otezla | Inflammatory Conditions |
| PegIntron | Hepatitis C |
| Phendimetrazine | Weight Loss |
| Phentermine Hcl | Weight Loss |
| Plegridy | Multiple Sclerosis |
| Praluent | High Blood Cholesterol |
| Privigen | Metabolic, Immune Disorders or Inherited Rare Disease |
| Procentra | Attention Disorders |
| Procrit | Blood Cell Deficiency |
| Prolastin | Metabolic, Immune Disorders or Inherited Rare Disease |
| Prolastin C | Metabolic, Immune Disorders or Inherited Rare Disease |
| Prolia | Bone Conditions |
| Promacta | Metabolic, Immune Disorders or Inherited Rare Disease |
| Provigil | Narcolepsy |
| Qsymia | Weight Loss |
| Quillichew ER | Attention Disorders |
| Quillivant XR | Attention Disorders |
| Ragwitek | Allergies |
| Rebetol | Hepatitis C |
| Rebif | Multiple Sclerosis |
| Remicade | Inflammatory Conditions |
| Remodulin | Pulmonary Hypertension |
| Repatha | High Blood Cholesterol |
| Restasis | Eye Conditions |
| Retin-A | Skin Conditions |
| Retin-A Micro | Skin Conditions |
| Revatio | Pulmonary Hypertension |
| Ribasphere | Hepatitis C |
| Ribavirin | Hepatitis C |
| Ritalin | Attention Disorders |
| Ritalin LA | Attention Disorders |
| Ritalin SR | Attention Disorders |
| Rituxan | Inflammatory Conditions |
| Ruconest | Metabolic, Immune Disorders or Inherited Rare Disease |
| Saizen | Endocrine Disorder |
| Samsca | Endocrine Disorder |
| Sanorex | Weight Loss |
| Saxenda | Weight Loss |
| Selzentry | HIV |
| Sensipar | Endocrine Disorder |
| Serostim | Endocrine Disorder |
| Signifor/Signifor LAR | Endocrine Disorder |
| Simponi/Simponi Aria | Inflammatory Conditions |
| Sivextro | Anti-infectives |
| Solaraze | Skin Conditions |
| Soliris | Metabolic, Immune Disorders or Inherited Rare Disease |
| Sovaldi | Hepatitis C |
| Spinraza | Metabolic, Immune Disorders or Inherited Rare Disease |
| Stelara | Inflammatory Conditions |
| Striant | Endocrine Disorder |
| Suboxone | Pain - Narcotic |
| Subsys | Pain - Narcotic |
| Supartz | Osteoarthritis |
| Symdeko | Respiratory Miscellaneous |
| Symlin | Diabetes |
| Synagis | Respiratory Miscellaneous |
| Synvisc | Osteoarthritis |
| Synvisc-One | Osteoarthritis |
| Syprine | Metabolic, Immune Disorders or Inherited Rare Disease |
| Taltz | Inflammatory Conditions |
| Tazorac 0.05% and 0.1% cream, gel | Skin Conditions |
| Tecfidera | Multiple Sclerosis |
| Technivie | Hepatitis C |
| Tenuate | Weight Loss |
| Testim | Endocrine Disorder |
| Testopel | Endocrine Disorder |
| tetrabenazine | Neurological Disorders |
| Tracleer | Pulmonary Hypertension |
| Tretin X | Skin Conditions |
| tretinoin topical products | Skin Conditions |
| Trulicity | Diabetes |
| Tysabri | Multiple Sclerosis |
| Tyvaso | Pulmonary Hypertension |
| Uptravi | Pulmonary Hypertension |
| Vascepa | High Blood Cholesterol |
| Veletri | Pulmonary Hypertension |
| Veltin | Skin Conditions |
| Ventavis | Pulmonary Hypertension |
| Victoza | Diabetes |
| Viekira | Hepatitis C |
| Viekira XR | Hepatitis C |
| Vpriv | Metabolic, Immune Disorders or Inherited Rare Disease |
| Vyvanse | Attention Disorders |
| Xeljanz | Inflammatory Conditions |
| Xeljanz XR | Inflammatory Conditions |
| Xenical | Weight Loss |
| Xeomin | Neurological Disorders |
| Xermelo | Gastrointestinal |
| Xiidra | Eye Conditions |
| Xolair | Asthma Specialty |
| Zarxio | Blood Cell Deficiency |
| Zavesca | Metabolic, Immune Disorders or Inherited Rare Disease |
| Zemaira | Metabolic, Immune Disorders or Inherited Rare Disease |
| Zenzedi | Attention Disorders |
| Zepatier | Hepatitis C |
| Ziana | Skin Conditions |
| Zinbryta | Multiple Sclerosis |
| zoledronic acid/mannitol & water | Bone Conditions |
| Zomacton | Endocrine Disorder |
| Zorbtive | Endocrine Disorder |
| Zubsolv | Pain - Narcotic |
| Zyvox | Anti-infectives |
